Effort To Help Russia Tackle Prenatal Woes Gains Federal Interest

BELLEVUE - Last summer, Bellevue radiologist Juliette Engel had just gotten off a plane from Moscow.

Engel spoke with enthusiasm about her plans to bring modern health care to pregnant Soviet women and their infants, who suffer among the highest complication and death rates in the industrialized world.

Her enthusiasm hasn't faded. Engel has left her practice at Overlake Hospital Medical Center to work full time to bring prenatal and obstetrical care to women living in what was the Soviet Union and is now the Commonwealth of Independent States.

And today, Engel is getting on a plane for Washington, D.C. For two weeks, she will be attending White House and congressional meetings making her pleas about how great the need is, and how a little foreign aid might do a lot.

"The problem is so enormous and the need is so great, and our resources are so limited," she says. "We can't supply them with everything they need, but we can supply them with the knowledge so that they can start doing these things for themselves. We found you can take condoms over there until you're blue but unless you really stress what they're for, they won't use them."

Engel's several trips to Russia in the past year were all made at her own expense, with other members of a nonprofit group she called Miramed.

The State Department, which recently formed the Citizen's Democracy Corps to coordinate private efforts and possibly provide funding, heard about Miramed from the Russian Foreign Ministry.

"Basically, what they're doing seems like a logical approach," Engel said of the U.S. government's effort. "Getting people already doing stuff together and forming task forces to focus on short-term and long-term aid."

Engel, along with Dr. Roy Farrell, representing the Seattle chapter of Physicians for Social Responsibility, will be on a task force on medical aid and will make recommendations to the State Department and Congress.

Last week the two met with a group of physicians and worked out what recommendations they wanted to make. The main thing they'll be pushing is preventive medicine. Farrell will talk about pediatric immunization. Engel will talk about prenatal education and care.

Education could forestall many of the complications women in Russia suffer from conditions acquired in pregnancy - prenatal diabetes, for example. "It's very common and easily controlled by limiting the sugar in the diet," she said. "But the end result without treatment is a very sick woman and a poor outcome for the baby."

Besides the lack of prenatal screening and evaluation, age-old folk beliefs are common and sometimes harmful, Engel said. "There are some real doozies," she said. "Like when you're pregnant, you shouldn't drink water."

Delivery practices also put both mother and child at risk. "Right after the babies are born, there's no resuscitation," she said.

"They're wrapped in a blanket and put at the other end of the room from the mother. They don't check the mother or the baby. It was all you could do to keep from running in there and cleaning out the baby."

Engel said the Russian women were eager for change and it was their frankness that helped her and her associates stand up to censorship where they found it.

Suspicious bureaucrats, she said, "followed us everywhere. They were just so intrigued that here was a group primarily of women who just bullied their way through the bureaucracy.

"We said, `We're here as women to help women, and we don't want you here,' and it worked."

Engel hasn't given up on her plans to help establish birthing centers similar to the one at Overlake, and officials in Russia remain committed, she said. But that's likely a long way off. In the meantime, she's hoping to get a dozen or so vans to go around the country promoting prenatal care.